常见皮肤病系列丛书第5本《毛发疾病》出版

患者女，38岁，因全身皮疹3个月，头皮剧烈瘙痒1个月，于2004年4月就诊，3个月前，患者无明显诱因外阴部出现散在的黄豆大丘疹，结节，随后皮疹泛发头皮，发际，颈侧，两侧腋下，腰部，腹部，腹股沟等处，且丘疹和结节不断向周围扩大，数周后形成环状损害，曾在多家医院被诊断为“银屑病”，给予乙双吗啉口服，糖皮质激素软膏外用。     

二期梅毒疹误诊为银屑病1例

患者女,38岁.因全身皮疹3个月,头皮剧烈瘙痒1个月,于2004年4月就诊.3个月前,患者无明显诱因外阴部出现散在的黄豆大丘疹、结节,随后皮疹泛发头皮、发际、颈侧、两侧腋下、腰部、腹部、腹股沟等处,且丘疹和结节不断向周围扩大,数周后形成环状损害.曾在多家医院被诊断为"银屑病",给予乙双吗啉口服、糖皮质激素软膏外用.治疗1个月后皮疹未见消退,反而逐渐增多,且头皮出现剧烈瘙痒.患者平素身体健康,本人及家族成员中无银屑病病史.否认有非婚性生活史、生殖器破溃史,发病前无全身皮肤黏膜发疹史.其配偶有非婚性接触史,但否认有梅毒等病史.     

儿童反向型银屑病一例

患儿男,3岁,因20甲变形10个月,头皮及皱褶部位皮疹1个月入院。患儿10个月前无明显诱因出现双手指甲增厚、混浊、变形,后逐渐累及所有指趾甲,并出现甲周红肿、脱屑、皲裂。曾于当地医院就诊,诊断为甲真菌病,予克霉唑软膏外用,小儿善存片口服2月余,皮疹无好转。再次复诊,诊断甲营养不良,扁平苔藓？予吡美莫司乳膏、丙酸氟替卡松乳膏外用1月余,皮疹无明显改善。1个月前患者头皮、双侧腋下、腹股沟、项背部、脐周陆续出现红斑、丘疹,轻度脱屑伴瘙痒。患儿既往体健,起病前未服用糖皮质激素、免疫抑制剂等,家族中亦无类似疾病史……     

黑棘皮病1例

临床资料　患者 ,男 ,3 5岁 ,工人。面颈部、腋窝皮肤变黑增厚 7个多月 ,于2 0 0 1年 8月来我所初诊。 1年前 ,患者从事当地钢厂炉前高温工作 ;7个多月前面颈部、腋窝开始皮肤变黑增厚 ,无明显自觉症状 ;5个多月前 ,停止炉前高温工作 ,病情进一步加重 ,面颈部、头皮、腋窝、肘窝、脐窝、腹股沟、外生殖器、窝、手足背皮肤均变黑增厚 ,粗糙 ,腋窝、腹股沟处皮肤呈乳头瘤状增生。一般情况尚可 ,自述食欲下降 ,体重下降 5ｋｇ ,家族中无类似疾病患者。无特殊服药史。体检　一般情况可 ,各系统检查未见异常。皮肤科情况 :面颈部、头皮、腋窝、…     

二期梅毒秃发1例报告

患者男,25岁,未婚,个体裁缝。主诉脱发1月。追问病史,10月前有冶游史,曾出现尿道流脓、尿痛。经注射“淋必治”而愈。不久冠状沟起结节,糜烂,腹股沟淋巴结肿大。经服西药半月,糜烂,结节消失,但腹股沟肿大淋巴结未退。4个月来自觉疲乏,全身不适,夜间易惊醒,1个月前发现脱发,渐发展。否认皮肤发生过其它皮疹。体检:系统检查未见异常。皮肤科情况:头顶、颞、枕部见指甲盖大脱发10多处,分布如网眼状,头皮正常,边缘头发不易松脱。皮肤未见其它皮损。双侧腹股沟淋巴结约1.5ｃｍ×1ｃｍ大小,质硬,与周围组织无粘连,无痛感。外阴部未见明显异常。血…     

皮肤颗粒细胞瘤一例

患者女,38岁,因左侧腹股沟起结节10个月,表面出现破溃伴轻度瘙痒1个月来我院就诊。患者自诉10个月前偶然发现左侧腹股沟出现一黄豆大皮下结节,无自觉症状,逐渐增大,     

红皮病型结节病一例

患儿女, 8岁,因皮肤红斑、丘疹半年,加重 1个月于 1999年 10月 15日入院。入院前半年患儿无明显诱因头皮出现红色斑丘疹,上覆少许鳞屑,未引起重视 ,后皮疹逐渐向全身发展伴轻微瘙痒,在当地诊断为银屑病,给予药物口服及外用药治疗（具体不详）,病情无好转,皮损逐渐增多,融合成片。 1个月前全身皮肤弥漫潮红,双侧腹股沟及颈项部出现包块,无畏寒、发热。在当地医院住院做骨髓穿刺示“粒细胞与红细胞比例偏低,红细胞系统增生活跃”,腹股沟淋巴结活检示“淋巴结结核”,右前臂皮损活检示“皮下纤维组织增生伴散在淋巴细胞浸润”,…     

并发口腔黏膜损害的二期梅毒1例

患者男,19岁.因头皮、包皮、阴囊、口腔先后出现丘疹1个月,于2007年3月30日来我科就诊.1个月前无明显诱因患者右侧上方头皮出现一甲盖大、白色较厚的鳞屑,搔抓后鳞屑脱落,基底渗血,随后头皮部渐出现5处类似皮损.     

婴儿白癜风1例

<正>1病历摘要患儿男,6个月。因全身散发白斑4个月就诊。患儿4个月前双眼角及眼睑出现白斑,逐渐扩大,之后陆续在头、口鼻周围、腋窝、腹股沟、臀部、手、足均出现对称性界限清楚的白斑。患儿系足月顺产,母乳喂养,患病以来饮食睡眠均正常。无家族免疫系统疾病病史,父母非近亲结婚,直系亲属均无白癜风病史。体格检查:患儿发育良好,对周围刺激反应正常。外观无畸形。生命体征正常,系统检查未见异常。皮肤科检查:全部头皮及发际、双眼上下眼睑少许、两眉弓及两眉间、口鼻周围(图1)、颈部、双腋下小片色素脱失斑疹或斑片,边界清楚,分布对称(图2A),手背、足背及侧缘(图2B、C)、阴囊、腹股沟及肛周臀部(图2D)     

家族性良性慢性天疱疮1家系报道

临床资料先证者，男，65岁，农民。因阴囊、腹股沟皮肤糜烂、渗出伴痒痛2个月于2004年12月2日来我院就诊。该患者自20岁起，无明显诱因出现头皮、背部及双侧腋窝散在多数水疱并伴有局部皮肤瘙痒。水疱大小不等，疱液澄清透明，稍擦即破，形成糜烂面，经数周可自行消退，以后又在原处复发。每年夏季发作，秋冬季自行缓解，工作生活不受影响。2个月前患者阴囊下方、腹股沟、双股内侧皮肤出现上述表现，水疱破裂后局部糜烂、渗出，皮肤增厚。曾在当地医院被诊断为“股癣”、“阴囊湿疹”，外用“曲安奈德”、“皮炎平”等效果不佳。糜烂面逐渐增大，增生明显，出现皲裂，伴有痛、痒感。     

Pemphigoid vegetans.

A 24-year-old woman had massive purulent and verrucous vegetations with fissuring in the groin and axillae. She also had scaling, crusted, bullous, and purulent lesions on the scalp, face, axillae, umbilicus, groin, and hands. Biopsy specimens of skin for histopathologic examinations and direct immunofluorescent study showed typical bullous pemphigoid, and serial serum samples tested by indirect immunofluorescent study confirmed the diagnosis. A basement membrane antibody was presented on four occasions at titers of 320, 1,280, 169, and 320. The differential diagnosis included dermatitis vegetans and pemphigus vegetans. An appropriate term for this manifestation of bullous pemphigoid is "pemphigoid vegetans."     

Lassueur-Graham-Little-Piccardi syndrome

A 52-year-old man presented for evaluation of patchy alopecia of the scalp, axilla, and groin and of follicular spiny papules. Histopathologic examination showed a dense, follicular, lymphocytic infiltrate and interfollicular interface changes. Lassueur-Graham-Little-Piccardi syndrome is characterized by the triad of scarring, patchy alopecia of the scalp, non-cicatricial alopecia of the axillae and pubis, and a keratotic, follicular eruption. There may be an etiologic relationship with lichen planus. Treatment is difficult, although isolated reports have demonstrated success with cyclosporin and thalidomide.     

Successful use of brachytherapy for a severe hidradenitis suppurativa variant

Hidradenitis suppurativa is a member of the follicular occlusion tetrad, along with acne conglobata, dissecting cellulitis of the scalp and pilodinal sinus. These conditions share common pathophysiologic features, including follicle occlusion, bacterial overgrowth, severe suppurative inflammation, scarring, and sinus tract formation. Treatment of severe cases is challenging, and a novel treatment modality would be of significant value. We describe a 46‐year‐old man who presented with a 15‐year history of suppurative and scarring nodules involving his groin, scalp, neck, face, and chest. Based on their distribution and morphology, these lesions were most characteristic of hidradenitis suppurativa, although he had features of acne conglobata and dissecting cellulitis as well. Over the years, he had been treated with several antimicrobial and immunomodulatory agents, the main conventional therapies for follicular occlusion syndromes, without much success. We then treated him with superficial brachytherapy to his right groin and occiput, which led to significant improvement. No toxic side effects were noted. This case demonstrates the successful application of superficial brachytherapy for the treatment of severe hidradenitis suppurativa, and possibly for other follicular occlusion syndromes.     

Unexpected location of pilonidal sinuses

Pilonidal sinuses usually occur in the sacrococcygeal area in young men, and occasionally can be found in other ectopic sites. We present a retrospective case review on unusual locations of pilonidal sinuses in the past 4 years. The lesion sites were as follows: one on the penis, two on the scalp, two on the abdomen, one on the neck, two in the groin and two in the axilla. Abdominal and penile lesions are uncommon, but the other locations reported are unusually rare. To our knowledge, the groin has not been reported previously as a site of a pilonidal sinus, although the histological appearance of hidradenitis suppurativa may well resemble it. When trying to clarify the pathogenesis of these occurrences, we found that recurrent hair removal was a common characteristic of the patients we contacted, and this may have been the initiating trauma.     

Lichen planopilaris.

P, a 20-year-old laborer displayed initial symptoms of the disease in question when he was 10 years old. Initially he had an asymptomatic progressive loss of hair on the scalp. A couple of years later he had mild to moderate pruritis, and the appearance of slate-blue eruptions on the scalp and elsewhere on the body. This resulted in a complete loss of hair on the vault of the scalp, which led him to seek specialist opinion. Skin surface examination revealed the presence of grayish-blue acuminate follicular papules, disposed singly and in groups (plaques). The pilo-sebaceous orifices were conspicuously obliterated and filled by keratin plugs. Perifollicular erythema was a predominant feature on the scalp. The lesions were present over the scalp, around the neck, chest, back, axillae, groin and legs. Shiny atrophied scalp skin depicting scarring alopecia mimicking male-type baldness was a salient feature. In addition, it was studded with conspicuous acuminate papules in its center (Fig. 1a). The known nonhairy (glabrous) skin had classic lichen planus lesions (Fig. 1b). Hemotoxylin-eosin stained microsections prepared from typical lichen planus (LP) lesions over the abdomen and those of lichen planopilaris (LPP) of the scalp were simultaneously studied. The former revealed changes in the epidermis comprising of hyperkeratosis, increase in thickness of stratum granulosum, hydropic degeneration of the basal cell layer and band-like lympho-histiocytic infiltrate pressing against and invading the epidermis, while the latter revealed uniform atrophy of the epidermis and vacuolization of basal cells. The hair follicles were dilated and were filled with keratin plugs. In addition to fibrosis of the dermis, pigment laden microphages and lympho-histiocytic infiltrate was prominent. The follicles and the sebaceous glands were absent. However, arrectores pilorum and sweat glands were preserved (Fig. 2a,b).     

Acromegaly presenting as cutis verticis gyrata

A 17-year-old Saudi male patient presented with progressive asymptomatic skin changes on the scalp for 4 years. Upon examination, he was a well-built muscular male with coarse facial features with broadening of the nasal bridge and thick lips. Scalp examination revealed multiple gyriform oblong skin folds in the fronto-parietal region (Fig. 1). Extensive velvety dark brown plaques were seen on sides of the neck, axillae, and groin. Similar eruption was seen on the knuckles of both hands and around the eyes. Clinical diagnosis of cutis verticis gyrata of the scalp and acanthosis nigricans was made. Because of the extent and the rapid progression of the above changes, acromegaly was suspected. Endocrinology referral confirmed this by the findings of high random growth hormone level at the value of 37.3 mIU/L (normal 0.2-13.0). Arrangement of magnetic resonance imaging (MRI) of the brain was made, but unfortunately the patient was lost to follow-up.     

Graham-Little-Piccardi-Lassueur syndrome

Graham-Little-Piccardi-Lassueur syndrome (GLPLS) traditionally describes patients with a triad of a multifocal cicatricial alopecia of the scalp, noncicatricial alopecia of the axillae and groin, and a lichenoid follicular eruption. The entity has caused much controversy with respect to both etiology and clinical definition. We present a patient with lichen planopilaris, lichen planus pigmentosus, and nonscarring alopecia of the genitals, who is reminiscent of GLPLS. Recent work shows evidence for autoimmunity in GLPLS. Further elucidation of underlying mechanisms can improve categorization and treatment options in this rare and controversial syndrome.     

Necrolytic migratory erythema in an opiate-dependent patient

An 18-year-old woman presented with severe features of seborrhoeic dermatitis involving her scalp. Subsequently, the toe webs and intertriginous areas became affected by an erythematous, slightly scaly and weepy rash. The groin area was most severely affected, and complicated by intermittent infections with staphylococci and herpes simplex. The patient admitted to smoking heroin and was subsequently enrolled in a methadone programme. A biopsy from the groin area showed a combination of parakeratosis and keratinocyte vacuolar changes, supporting a diagnosis of necrolytic migratory erythema (NME). On completion of methadadone withdrawal, the rash cleared. The rash returned upon recommencing methadone. NME consists of an irregular annular eruption with an erythematous crusted edge. It is often mistaken for intertrigo or seborrhoeic dermatitis. In this patient, a direct effect of heroin and methadone on the epidermal metabolism might be speculated. There could be a variant of the opiate recepter, which is especially sensitive to the effects of opiates. This is the second case occurring in association with opiate dependency and the first case where the patient was rechallenged, although the precise role of the opiates in the aetiology remains somewhat speculative.     

White piedra--a case report and review of the literature

White piedra (trichosporosis) is an unusual fungal infection of hair characterised by the presence of numerous, discrete, soft, asymptomatic nodules attached to the infected hair shafts. It may occur on the scalp, eyebrows, eyelashes, beard, axilla, or in the groin (Smith, Murtishaw & McBride, 1973; Taplin & Rebell, 1979a), although most infections occur on the face or scalp (Smith et al., 1973). Caused by the yeast-like fungus Trichosporon beigelii, white piedra was first described in London (Beigel, 1865), and has since been reported in Europe, North and South America, and Asia (Scott, 1951; Benson, Lapins & Odom, 1983). Successful treatment of white piedra has been achieved with simple hair clipping and with the use of various topical medications. To our knowledge, there have been no reports of successful treatment with the use of topically applied imidazole preparations. We report a case of white piedra confined to the scrotum that responded to topical clotrimazole lotion.     

Fungal infections in children

Fungal infections of the skin represent a relatively common problem in pediatric dermatology. Although fungal infections of the feet, nails, and groin are uncommon in the pediatric age group, fungal infections of the scalp are very common and must be diagnosed early because they may lead to permanent hair loss if left untreated. Perhaps the most significant change in fungal infections in children has occurred in tinea capitis, including the causative agent and the type of infection this organism may produce; these factors are focused upon in this article. Also discussed are infections caused by the yeast organisms Candida albicans and Pityrosporum orbiculare, as well as the deep mycoses, specifically chromoblastomycosis and cutaneous aspergillosis.